Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
24 Dec

Dairy Intolerance: What It Is and How to Determine If You Have It

Dairy IntoleranceI often say that “dairy is fine and even healthy if you tolerate it.” But what exactly does that mean? How do you know if it’s “not okay”? You could be reacting poorly to the lactose, the casein, the whey, or all of it. You could just ditch all dairy forever more and be perfectly fine – but you shouldn’t eliminate a food group, especially one as delicious, nutrient-dense, and potentially rewarding as dairy, unless you absolutely must. Plus, it’s just good to know what you can and cannot tolerate. You don’t want to tiptoe through life, scared of food because you’ve never taken the time to determine your ability to tolerate it. You want to be empowered with knowledge and venture forth boldly – or carefully, if caution is warranted – through the cheese aisle.

The most common dairy components that people have trouble with are lactose and casein, with intolerance to each presenting differently. Let’s look at both.

Lactose Intolerance

Lactose intolerance occurs when people stop making lactase, the digestive enzyme located along the small intestinal wall that breaks lactose into glucose and galactose for easy digestion. This usually occurs around the age of four or five (lactose intolerance is incredibly rare in infants, for obvious reasons). Without lactase, lactose is instead metabolized by bacteria, which can cause stomach upset, flatulence, diarrhea, bloating, nausea, and a host of familiar but unwelcome gastrointestinal symptoms also seen in FODMAPs intolerance. In fact, the disaccharide lactose is a FODMAP. Lactose intolerance generally isn’t life threatening (unless you’re a baby who depends on a lactose-containing food) but it is annoying and can make life difficult and unpleasant.

Causes: Most lactose intolerance develops because people stop producing lactase after weaning. No more breast milk, no more need to expend the energy necessary to produce lactase. This is usually genetically determined, and people with milk-drinking ancestry are far more likely to possess the gene(s) for lactase persistence (it takes just one copy to keep making lactase into adulthood).

Some lactose intolerance is transient and stems from damage to the epithelial cells lining the intestine, which are responsible for producing lactase in the gut. If something like viral gastroenteritis or food poisoning damages enough gut lining, lactase production and thus lactose digestion may be hampered for the duration of the sickness.

Other lactose intolerance stems from gut dysbiosis. Many gut bacteria, particularly Lactobacillus, produce lactase that help the host (that’s us) break down and absorb lactose. If your gut flora composition is missing the right species or overcrowded with the wrong ones, lactase production may suffer.

Prevalence: About 75% of the world’s population shows decreased lactase production into adulthood, but distribution varies wildly by ethnicity and nation. Looking at this global map is probably a better way to understand the prevalence of lactose intolerance than throwing out a single number. Among Northern Europeans, who have a long history of dairy consumption, prevalence is around 5%. In most of Sub Saharan Africa, where dairy is rarely consumed, lactose intolerance nears or surpasses 90% prevalence.

How to determine: The medical profession uses two main tests for determining lactose intolerance. Both involve the test subject consuming a lactose-rich drink. The hydrogen breath test measures the amount of hydrogen in your breath. If you’re unable to digest lactose, any lactose you consume will make it to the colon to be digested by hydrogen-producing bacteria; this hydrogen will show up in your breath. Another option is the blood glucose test. If your glucose doesn’t go up after eating lactose, you’re not cleaving it into digestible monosaccharides and you are probably lactose intolerant.

At home, a simple test is the oral challenge: eat some lactose powder that you’ve mixed into water and see if any of the previously mentioned symptoms arise. Start with 25 grams of lactose, which is the amount found in two big glasses of milk. I would advise against using milk itself, since milk contains both whey and casein, and it might be difficult to parse which component you’re responding to. Even though lactose powder is a processed, isolate, refined component, it doesn’t really matter much since whole food lactose is identical.

Dairy Protein Intolerance

A dairy protein (whey or, more commonly, casein) intolerance is different than a full-blown allergy. In an allergy, consumption of the offending food elicits an immediate, acute, unmistakable immune response. You might get severely plugged sinuses, itchy skin, hives or rashes, hypotension, diarrhea, vomiting, an elevated heart rate, and have difficulty breathing. Tests can confirm it but you’ll probably already know you’re allergic. If a swig of milk causes anaphylaxis, you don’t need a post on MDA telling you to drop it for 30 days and reintroduce it. You’re already in the know.

Intolerances to the proteins in dairy are a bit more confusing. Some of the symptoms are similar to, if milder than those of allergic reactions. For some people, it manifests as constipation. For others, diarrhea. Still others get tingly fingers, joint pain, and a foggy head. Whatever the symptoms of a dairy protein intolerance, they usually take longer to appear, making identification difficult. Plus, little scientific consensus exists on the nature of dairy protein intolerance. There are no universally accepted lab tests and few medical professionals will be able to help. Casein seems to be the most common dairy protein people are sensitive to; it’s far more rare for whey to be an issue.

Prevalence: According to population-based studies, the prevalence of cow’s milk protein allergy ranges from 0.25 to 4.9% of young children. It’s less prevalent among adults and older kids. Official numbers for milk protein intolerance prevalence are unknown because the condition itself is relatively unknown in the medical community.

How to Determine: You can do skin prick tests or shell out the dough for expensive food sensitivity lab results (that may not even tell you anything definitive), but the gold standard remains the food challenge: strict avoidance of the suspected food until symptoms subside followed by an oral challenge.

It seems like the simplest way to perform an oral challenge would be to eat some whey isolate or casein protein powder. After all, that’s just whey or casein, right? That may work, but I don’t think the results would necessarily transfer over to other sources of whey (like milk) or casein (like Greek yogurt). Unfortunately, the way we process dairy seems to change the structure of the proteins and, thus, their potential for reactivity. Fermentation of yogurt alters protein peptides. Heat treatment has been shown to make casein more allergenic and resistant to digestion by infants, while kids with cow milk allergy, for example, can tolerate baked milk fairly well – although that may be a function of quantity since “baked milk” is shorthand for “baked goods containing milk,” which are mostly flour and sugar, not milk protein.

So, given the fluid nature of dairy protein in response to processing, you may have to determine your tolerance of specific types of dairy to get an accurate picture.

The basic idea is to remove all dairy for at least 30 days. This gives your body a reprieve that, according to some, is necessary to re-sensitize your body to potentially problematic proteins. If dairy proteins are inducing a low-level inflammatory state that lasts for days or weeks and muddles the message, you need a solid chunk of time without any for reintroduction to provide accurate information. So skip the cheese, the milk, the cream, even the butter (I’m sorry) for 30 days if you suspect you have a dairy intolerance. Then, introduce dairy foods one by one, giving yourself two or three days to ensure lack of latent response before trying a new one.

Casein-rich foods: most cheeses, Greek yogurt (yogurt with the whey drained), cottage cheese, casein protein powder

Whey-rich foods: ricotta, whey protein powder

Foods with casein and whey: milk, yogurt, kefir, butter

Causes: A major, and in my opinion likely, candidate for the cause of dairy protein intolerance is intestinal permeability, or leaky gut. An overly permeable intestine (all intestines are permeable to a certain degree; it’s excessive permeability that’s the main issue) allows protein fragments from the digestive tract into the bloodstream. When the immune system identifies these errant proteins as invaders, it does what it does in response to any other invading pathogen: mount an attack and fortify the body’s defenses by releasing histamine (which tries to get rid of the “pathogen” by inducing diarrhea, sneezing, runny nose, watery eyes, and all the other symptoms you might get from an allergic or intolerance reaction). In a perfect world, casein may not be inflammatory in and of itself, but its presence in the bloodstream can invite an inflammatory response.

What to Do

Say you’ve figured out you have an intolerance but you still want to eat dairy. What can you do?

If it’s lactose intolerance, you can beat that. Chris Kresser explains how to go about it.

Try different kinds of dairy. Try raw. Try fermented. Try grass-fed. Try organic. Try sheep. Try goat. Try camel, even. Try hard cheese, aged cheese, soft cheese. Try yogurt or kefir. Try ghee. Try A2 dairy. In other words, you may not be intolerant of all forms of dairy.

Fix your gut; make it less permeable. Easier said than done, I know. Here are some things to try or track to tighten up those tight junctions:

  • Be vitamin D replete. Activation of the vitamin D receptors on the intestinal wall inhibit intestinal permeability. If you lack adequate vitamin D, your gut permeability may increase, leaving you open to dairy intolerance.
  • Eat fermented foods and/or probiotics. One study (highlighted by a reader last week; hat tip to you) showed that adding a probiotic strain to dairy could inhibit intestinal permeability.
  • Feed your gut flora with prebiotics. Prebiotics like inulin and resistant starch (which I discussed here) have been shown to increase butyrate production and reduce intestinal permeability.
  • Get a handle on stress (or change how you approach it). Stress can increase intestinal permeability and disrupt your digestion.
  • Exercise regularly. This can attenuate the stress-induced permeability.
  • Watch your omega-6 intake and be sure to get your omega-3s. Omega-6 PUFAs lower occludin in tight junctions, making them not so, how you say, tight. DHA had the opposite effect.

The main message here is: Be methodical so you know what’s really going on. This is where The Primal Blueprint 90-Day Journal will really come in handy.

What do you think, readers? Do you suspect you have a problem with dairy? Think you’ll give it a shot and try to get to the bottom of it?

Thanks for reading, all!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. OK boss I need 30 days off. I think I might be allergic to work and we best reintroduce it slowly :)

    Groktimus Primal wrote on December 24th, 2013
    • You made me snort my drink. :D

      Aria wrote on December 24th, 2013
    • I gotta try that one at work for a good laugh.

      blop2008 wrote on December 24th, 2013
    • wow I did it , my boss is very understanding and he gave a gift, very pretty pink slip :-)

      wildgrok wrote on December 24th, 2013
    • All of this information is fascinating, but absolutely overwhelming. I cannot seem to keep track of solving and keeping track of all the things that are going wrong with my inflammatory conditions and how to resolve them; and, I am very well educated, extremely interested in the topics and truly want to get well. I have been dealing with these issues for over 20 years and there is so much conflicting information (believe me, I have tried, it seems, almost everything!), I do not know what to do anymore.

      Rachel wrote on December 24th, 2013
      • You need to read this:

        http://www.marksdailyapple.com/dont-let-the-perfect-be-the-enemy-of-the-good/#axzz2oV8AWHJA

        And then possibly stop reading :P

        If you can’t solve your issues with diet it may be time to find a Naturopathic Doctor who can naturally push your body into the next steps of healing!!! I am on the same path only I have only felt like crap for 7 or so years. I think it’s time for me to see the pros work their healing magic because diet/exercise alone wasn’t enough.

        And NEVER underestimate the power of STRESS. Stress could be the ONLY piece of the puzzle for some because it has the power to cripple every bodily system and cause chaos in your body if not kept in check. A sample:

        http://chriskresser.com/how-stress-wreaks-havoc-on-your-gut

        Ryan wrote on December 25th, 2013
      • I sympathize with your efforts to improve your health–I’ve been a vegetarian, moving on to veganism and raw food diets for years. Recently I was diagnosed with a dairy allergy–not a sensitivity/intolerance and the dr. suggested I stop dairy. Long story short, I no longer get severe sinus infections (10+ per year that required toxic rounds/strains of antibiotics and loss of work). In July 2013 I adopted the Paleo lifestyle. In addiiton to feeling phenomenal, I no longer take antihistamines for allergies!

        Michaela wrote on December 26th, 2013
      • Don’t know if this will work for you or not, but it is worth a try and only costs $219 if you pay cash instead of trying to get insurance to cover it. I had major diarrhea issues and went to a naturopath who had me tested at Great Plains Laboratory in Kansas. The test to request is their IgG Food Allergy Test w/ Candida. It pinpointed many food sensitivities which I initially followed. It was very restrictive so I tried to just stay away from the foods that tested either in the moderate or severe range and am still doing well. I had my nephew tested also (he has Inflammatory bowel syndrome and Rosacea….both autoimmune issues) and since he has discontinued ingesting his highest rated foods he also has improved. Hope this helps.

        Diana wrote on December 31st, 2013
      • Amen Brother;)

        Michelle wrote on April 25th, 2014
  2. I have a pattern where I’m fine eating dairy at first, but after a week of daily dairy I start to get gastritis (sensation of burning in my stomach) which can become pretty uncomfortable. No other symptoms. I’ve never understood this. The worst offenders are butter and yogurt. Even the finest pastured full-fat yogurt, if I eat it every day, will take me down. Cheese seems to be the easiest on me. Maybe whey is the problem.

    Alice wrote on December 24th, 2013
    • Hmm, my wife complains of this too – stomach pains if she eats yogurt for more than two consecutively. Every once in a while doesn’t bother her at all. Cheese and butter are fine for her.

      I LOVE dairy foods and alas, cannot eat them at all anymore. I have tried everything, and I do mean everything (raw, pasturized, 100% grass-fed organic, ghee, yogurt, milk, butter, etc, etc, etc), but I react to all of it with skin and sinus issues the next day. I guess I could have some leaky gut going on and if I fix that I could try the dairy again… I’ll report back if I ever manage to fix that.

      Edmund Brown wrote on December 24th, 2013
      • I have the same responses….my problems with eczema improve almost as soon as I eliminate dairy, and I have tried A2 cream, etc. without much difference. The sad thing is, I believe beef may also be an issue since it is cattle protein, and I used to feel puffy and uncomfortable with it; however, I have been adding fermented foods (kimchee, sauerkraut, real pickles) and I seem to be having better results, even with beef. The heart rate test is one easy way I have determined other allergies, such as grains way back in the day. I am looking to see my chronic sinus problems improve….that will be a genuine miracle! Thanks for your comment!

        Susan wrote on December 25th, 2013
        • I have something similar with dairy as well. When I lived in Texas, I drank raw milk and I always had a bit of eczema, but nothing major. We moved up to Jersey, where it’s illegal to sell raw milk, so I switched to organic whole milk. Within a week, I had the worst flare ever, so I had to go (mostly) dairy free. I can tolerate butter and goat / sheep dairy, so I eat that. It’s sad, though – I miss my milk!

          Liddlem wrote on December 26th, 2013
    • Hideho neighbours,

      In a lot of yogurt products and other dairyish products, you’ll find carrageenan..

      Checked online, it is a known cause of bowel inflammation. Go figure..
      So when we think we’re eating yogurt for our bowels, we’re ingesting carrageenan at the same time.
      There is greek yogurt out there without it, found that so far.

      John Guy wrote on December 24th, 2013
      • The most pure natural yogurt I know of is from Seven Stars Farm. No other ingredients at all, just organic milk and cultures. Get the plain, whole milk kind- there’s a layer of lovely cream on the top.
        The farm is in Phoenixville PA; we visited it (unannounced) and saw contented grass fed Jersey cows coming in for milking time. The yogurt is sold in natural food type stores. No carrageenan in it, which folks SHOULD avoid. A friend told me when she worked in research for a pharmacuetical company they used carrageenan to give the rats arthritis so they could test the arthritis drugs.

        Mary wrote on December 26th, 2013
        • +1 re. Seven Stars Farm Yogurt – it’s the only yogurt I’ll buy.
          Plain, full-fat goodness mmm…..

          Holly wrote on December 26th, 2013
    • If there’s a leaky gut, one small snack of dairy might not be enough to induce a reaction, but regular dairy might tip the balance, perhaps?

      Easy enough to avoid carageenan by making your own yogurt. :)

      crunchymama wrote on December 24th, 2013
  3. For years I thought I was lactose intolerant, until one day I dared to have a cup of organic milk, and lo and behold my body loved it. No symptoms at all. Turns out, I’m not lactose intolerant, but there’s something else non-organic milk that I can’t have. I have no idea what that something is though. Anyone have any ideas? I’m guessing it’s some sort of chemical or hormone, but maybe someone can shed some light on this…

    Andreia wrote on December 24th, 2013
    • All organic milk that I have come across is UHT (Ultra High Temperature) Pasteurized. From my understanding this process actually alters the casein.

      “Not only do pasteurization and UHT processing kill off the enzymes present in milk needed to digest the casein, the casein itself is altered to the point of being indigestible”

      Source: http://www.foodrenegade.com/just-say-no-to-uht-milk/

      Perhaps you are allergic to casein and since it is no longer being digested your issues have disappeared?

      Ryan wrote on December 24th, 2013
    • The homogenization and pasteurization of milk and milk products creates a “food” the body does not recognize, and hence can become problematic (and yes, I am reducing the science to simple terms for the sake of clarity).
      Most people who claim to be “lactose intolerant” will actually not react to fresh, RAW milk…

      MR PALEO wrote on December 24th, 2013
  4. I stopped drinking milk in my 20s, for ideological reasons, then decided to try it again about 7 years later to see if I could actually digest it. It tasted awful, I could barely get down an ounce. Then about 1-2 hours later, I started to smell like stale milk. Diarrhea at 4.5 hours, then that was it. No more milk for me! I can tolerate small amounts of milk in baking (which is another story) but even there I can overdo it.

    Interestingly, my mother told me I couldn’t tolerate whole milk as a baby and needed 2%, but I don’t seem to have any problems with cheese or butter now. I have no idea what that’s about.

    Anemone wrote on December 24th, 2013
  5. My dairy issue is complex. I can eat cheese with no apparent distress, but milk and cream are two things that I think it is accurate to say I am addicted to. I was already wheat and sugar free when I eliminated dairy for 30 days and in that time I promptly lost 12 pounds. I am not sure if I eliminated bloat that was caused by the dairy or what. I know that I feel lighter and better physically without it, but it has been a co-habit with sugar so it is a hard thing to put down. Though that may be the best reason to do just that.

    Kimberly Robinson wrote on December 24th, 2013
    • I have a problem with losing weight while eating dairy. When I went on an auto immune diet, I lost 15 lbs in a month, huge for me. I think dairy is addictive for me because if I start, I want more and more (of course it is just delicious….) I wonder if it is an A2 cow thing. Or is it just the lower calories that cause the weight loss – I can eat a lot of dairy when I do it. I also do not feel symptoms that I can link to dairy, but I do have a cronic low level inflammation.

      Lynne LaVAlley wrote on December 31st, 2013
  6. I typically avoid dairy like the plague, but today being Christmas Eve, I threw all caution to the wind and had a cup of lactose-free egg nog. It gave me a bit of a bellyache and an hour later, I need a nap. Not worth it!

    Jenny wrote on December 24th, 2013
  7. There are other issues that can contribute like stomach PH and people taking stomach acid blockers preventing proper digestion:
    http://high-fat-nutrition.blogspot.com/search/label/Casein%20and%20gluten%20and%20gastric%20pH
    There’s also good argument that casein hydrosylates open up tight junctions in gut if not properly digested. http://high-fat-nutrition.blogspot.com/search/label/Casein%20vs%20gluten
    Also keep in mind that partially digested milk protein peptides have trigger morphine receptors in the brain. (similar to wheat)
    Also consider that the types of proteins in modern cow milk are different than the proteins that were in most old time cows (pre 70s). The world has been converting to using mostly Holsteins which produce A1 protein milk but old school cows (and goats, sheep, etc) produce mostly or all A2 protein milk. A1 milk seems to release much more BCM7 which is a morphine like substance and ability to clear BCM7 from the system has a lot of genetic variation. Controversy about A1 and A2 milk is beginning to heat up, here is some info on A1 vs A2 protein milk: http://www.a2milk.com.au/faq.php
    Early research on A1 vs A2 has been very interesting and if it pans out, could explain a lot. Plus the jury is still on effects of homogenization, pasteurization, and filtration (all of which have potential to change protein structures), addition of permeate to water down milk, use of growth hormone and antibiotics, use of GMO feed, lack of grass feeding, rampant udder infections, and large quantities of pus now present in most milk supplies. The milk of today is vastly different than the milk of the past.

    Eva wrote on December 24th, 2013
  8. I’ve always been somewhat puzzled by my bodily responses to dairy. When I was a kid and clear up to my 20’s in the Army, I drank tons of milk, ate cheese, cheesecake, you name it, and never got the correlation to the fact that I frequently got sore throats, sinus infections, etc. I never experienced any gastrointestinal distress from dairy products, but went cold turkey years ago when I realized that it caused other problems. From what I read in your article, I get that it’s likely a protein issue. 2 years ago 1 tried some raw cow’s milk (1 large glass) and it was wonderful and I had no problem. Perhaps it becomes an issue with quantity. Good to read everyone’s input.

    Ron wrote on December 24th, 2013
  9. Great timing! This is such a hot topic these days. Why should I stop using dairy when I know that I don’t have an intolerance? (For the record, I’ve done several Whole30 and eliminated for the entire time.) Why does that make me less paleo? Isn’t this lifestyle about learning more about our own bodies and less worrying about other’s?

    I’m thrilled to have a post that I can easily site now. thanks!

    Tamara (New Orleans) wrote on December 24th, 2013
  10. I think dairy is related to lifetime seasonal allergies for me, but cutting it out may only fix the problem if I also cut out grains. the last two spring seasons have been wonderful – that’s when I went from primal to Paleo. I am enjoying some dairy during the off season, though I think it contributes some congestion.

    Karen wrote on December 24th, 2013
  11. I am lactose intolerance. I can eat some yogurts, and mozzarella cheese. I can’t drink milk, or eat ice cream. I found that taking Lactaid, and probiotics really help to prevent gas. My GI problems got much better after eating a low carb, high fat. No sugar, no grains…FTW!

    Alan wrote on December 24th, 2013
    • I have the same problem with ice cream, haven’t had it in years, and I love ice cream.

      Joe Bob wrote on December 24th, 2013
  12. This article comes at the perfect time because I’m exploring lactose intolerance for my 2 year old son. He’s always been gassy/colicky since he was born and has always had issues sleeping. I never suspected milk or dairy until he had the stomach bug a few weeks ago and the doctor told us to cut out dairy for a week until he was better. Well that week he didn’t have milk he seriously turned into a different kid! He was happy, calm, not gassy, and slept 12 hours straight at night! That’s when I started to think maybe dairy was an issue for him. Talked it over with doc and it was suggested we try lactose free milk and see if it makes a difference. It’s only been a week so it’s hard to say at this point, but sleep has been good so far. Doc said it runs in the family, which makes sense since my father is very lactose intolerant and I have recently not been able to drink milk or eat ice cream without getting stomach cramps. My only concern with lactose free milk is that I can’t seem to find organic lactose free whole milk (my son is on the skinny side and I’d prefer to keep him on whole milk at this point) and they are all “ultra-pasteurized” which I’ve read is more processed and less nutritious.

    Andrea wrote on December 24th, 2013
    • I have the same problem with my son. We’ve observed issues with dairy with him throughout the years and eliminated lactose and saw improvements but then reintroduced dairy when he got past those milestones. Such as colic as a baby (no dairy for me either), wetting the bed more with dairy, sleepwalking at night more with dairy, etc. We also tried a sort of half hearted GF/DF approach with more consistency on the GF side and focusing on lactose versus casein.

      This winter, he’s had constant ear infections and fluid in his ears. This is affecting his hearing and we’ve eliminated all dairy and casein rigorously in an attempt to avoid ear tubes. We did this about 10 days ago and I can’t believe the difference in him! He is speaking in a more natural manner, more socially clued in, not complaining of being tired, smiling so much more, making new friendships at school, not making weird noises and gestures, and not constipated. I feel like we’ve unlocked his true self. He is not autistic, gets great grades at school, and has an extremely high IQ but socially he was very behind and often disruptive. I felt like he was rarely emotionally present with me and we had decided on counseling and play therapy for him although he’s only 6. I am so thankful to God that we have finally completely eliminated all dairy and that we can see the real him.

      I don’t know if there is a lactose or whey component but there is definitely a casein because we’ve tried eliminating lactose before but still including raw cheeses and butter with some improvement but not as dramatic results as we are seeing now.

      I know I have always been a bit sensitive to milk, as a kid I had chronic colic and terribly painful gassy tummy so often. Ice cream in particular makes me feel awful and I’ve excluded that for years, preferring coconut ice cream. My husband has eczema issues and candida issues and I suspect a link to dairy as well.

      We are just starting our exploration, and taking it one day at a time but I find the following fascinating. I haven’t had time to fully vet all these facts but I wonder if it is really true that people typically just react to either casein or lactose but not both, when lactose intolerance is already so widespread. From what I read, casein and soy have a similar protein structure, so there may be issues there. I personally definitely do better with raw cheese or blue cheese and kefir and worse with milk, ice cream, butter, and yogurt. This suggests lactose as the culprit to me (sour kefir and hard cheeses probably have less lactose). But from what I understand, lactose symptoms are mostly digestion and elimination related and what I experience is brain fog, disorientation, and mucous. From what I’ve been reading, these are symptoms of casein, not lactose. This would also go for what we’ve been observing with my son. So I think it’s quite possibly there’s an issue with both. Or a leaky gut. Or all of the above.

      Faith wrote on May 16th, 2014
  13. Are any of the issues raised above related to beef intolerance? I have been getting an upset digestive system after eating beef, and I am also lactose intolerant. Thanks for the informative article, BTW

    Walter Schwager wrote on December 24th, 2013
    • My brother can’t eat beef. It makes his hands and fingers hurt. Beef is high in arachidonic acid, which causes inflammation in some people. Try bison instead.

      Shary wrote on December 24th, 2013
  14. Very thorough article. I did the ALCAT test this Spring and it showed I had a severe intolerance to whey. I cut it out (and my other severe intolerance, white potato) and almost immediately lost weight. I am debating on trying them again since its been so long. Hoping all the probiotics have helped too.

    Carey Huyser wrote on December 24th, 2013
  15. Marko–
    I like the new, fresh taste of whole, organic milk–and org ice cream, and can tolerate it, too. To some degree. Having reduced my dairy to no more than A serving per day, and having gone OFF dairy for some 5 days at a time, as well as grains, I can tell you that it is a fact that: “I cam even feel just one serving of dairy, and grains, too, when I add them back, This is not in the form of GI Tract symptoms, but rather in the soreness that comes back into my musclo-fascia body the next morning…

    My other food/healer guru, a very passionate micro-biologist researcher and naturo-pathic healer, is a STAUCH ADVOCATE AGAINST DAIRY and GRAINS, and who likes most of your ideas, but really DISAGREES with your slipping towards dairy as a paleo guru.

    The bottom line is, in the final analysis and to cut to the chase, we are not as a biological species ready for proper dairy consumption as adults, even in the face of 8K yrs of potential micro-evolution…so, we are better moving towards little to NO dairy, except goats milk…

    Greg Turner wrote on December 24th, 2013
  16. I’ve looked into the milk and ice cream and yogurt issue versus cheese and butter issue. Turns out it is the lactose if milk or certain yogurts causes reactions.

    Kiefer is 99% lactose free and I can digest it fine even as a cheating vegan who has it once ever three months. Creamy cheeses not so much, harder cheeses are fine for me. Icecream are no go. Butter in small quantities are a ok! (Who uses a lot of butter when cooking paleo is beyond me anyway. I’m not paleo but I’ve come to appreciate Mark’s blog and writing because vegan and raw isn’t for everyone and there is useful information that the vegan community could benefit from here. Either way, Butter being ok on a paleo lifestyle never means to use a pound of it at one go anyway.
    Tried and true on the paleo/raw/vegan front. I was vegetarian for 18 years and decided to amp it up. my husband went vegan with me over a year ago and he didn’t respond well. Lost too much weight and he looked tired all the time. Granted I’m a creole lady and he is Russian/Lithuanian. Which might explain things in terms of genetically based diets. Since reading the daily apple I began thinking, maybe my husband is a caveman lol. And yes, he is :D)

    Lactose can be more of an issue for most people I think either way because he also can’t have a ton of milk, but he can throw down on cheese as much as he wants. Isolated whey which has less lactose seems to not bother me, but full fat, full cream, lactose cauldrons of evil do.

    I guess the key is just listen to your body and don’t force things. And I do think ancestry plays into it. My husband and I are like night and day racially and genetically, and we respond to diets this way too. Even so, dot do an ancestor based diet either, we are evolved creatures and some things still may not be a good option for us as it was to our forebears. Native Americans smoked tobacco without overwhelming ill effects. my father did too, now he has cancer, his genetics didn’t protect him from it.

    Research, try it, do what works :D

    Animelady wrote on December 24th, 2013
  17. In the 1960s, middle-class women didn’t breast feed, so cow’s milk was given to newborns. Apparently, I had terrible colic and severe gas pains on cow’s milk, so the doctor “prescribed” Karo (corn syrup) and Carnation (which is made of milk, right?). Weird. Hard to believe I even developed well on corn syrup. They finally transitioned me to milk because I remember drinking it in school up until I was 13. At that point, I got severely bloated every day after lunch. The doctor prescribed Reglan, which caused blurry vision, muscle spasms so bad I couldn’t walk and landed me in the emergency room. I stopped drinking milk and my symptoms got better. So, I know I’m lactose intolerant. I can eat aged cheese, like Cheddar, and buy a brand that has been aged long enough that no lactose is left. However, it wasn’t until I cut out dairy completely (to see if weight loss would be easier) that I realized that dairy makes me constipated. I still have cheese once a week, but always as a condiment, sprinkled on a salad. I use a potent cheese, which gives a lot of flavor, with very little needed. So, maybe that makes me casein-sensitive too.

    Kim wrote on December 24th, 2013
    • It almost makes me want to cry thinking about how much better the access to knowledge is these days. When I was born in ’57, I apparently had severe colic and would cry most of the night and couldn’t sleep. Our doctor obviously didn’t have the knowledge to even suggest taking me off cow’s milk and corn syrup, but he did prescribe phenobarbital to force me to sleep through the night instead of catching most of my sleep during the day from sheer exhaustion. I realize it must have been very hard on my parents to have a screaming baby at night, but I’ve had to deal with insomnia my whole life (and have just started getting a handle on it because of all the research I’ve done in that area).
      Too bad they didn’t think to get to the root of the painful colic instead of drugging me as an infant. Parents are SO much better informed these days and it makes me happy for all the little ones out there with similar problems….

      Tee Dee wrote on January 4th, 2014
      • TD,

        Try a GOOD daily high-potency multi-B, and Mg chloride spread on your body from below the breasts to above the pubic bone. Without lab tests, it is tough to determine the cause of your problems… probably hormone and/or cortisol problems as well… besides any dairy issues.

        MR PALEO wrote on January 4th, 2014
        • Thank you, Mr. Paleo, I really appreciate your input, and will try the Mg chloride cream. I’m taking a good multi, plus B’s, and I’ve been thinking I should get one of the tests some have mentioned through Cyrex Labs. Perhaps that will cut to the chase? I know a lot of women in their 50’s are doing the hormone replacement therapies, but I’m very wary of that route; lots of conflicting theories out there.
          Take care and thanks again…

          Tee Dee wrote on January 5th, 2014
  18. When I was a kid I used to consume a lot of dairy with no problems at all – bowl of cereal for breakfast, yogurt and milk during the day, glass of milk every dinner etc. Then in my early mid 20s I started to get mild diaherrea from it. Took a while before I realized that was the cause. I switched to toast in the mornings and could tolerate a small amount in my coffee, some cheesse with meals and occasional icecream etc. with no problems at all.

    Fast forward to my early 40s, switched to Paleo and dropped dairy completely except occasional part of a cheat meal.

    For many years I had been getting ocassional large pimples / boils on my legs. It took a couple of years to make the connection and many months of observation to confirm it but something in cheese (especially soft cheese), ice cteam etc. was the cause of the pimples. One or two days after eating dairy I would get one or more large pimples depending on the “dose” I had eaten. Theyd take often a week more more to heal.

    A few weeks ago I started working on improving my gut flora to see if it would help with some other minor health issues. Probiotics, kefir and resistant starch. Then I went on vacation for a week and splurged a large part of my yearly 20% eating and drinking large qtys of everything I shouldnt … but with no reaction to any dairy. I wasnt trying to test my dairy tolerance and didnt go overboard with it, but I did eat icecream amd pizza enough times to give me a lot of problems in the past.

    When the silly season is over I’ll have to try a more controlled test. But right now I think I may have “cured” my intolerance unintentionally.

    BTW … took me a long time to make the connection and then “prove” dairy was giving me pimples / boils on my legs. Seems like a strange reaction. Anyone else ever have this?

    James wrote on December 24th, 2013
    • James I too have been wondering if pimples on my scalp have anything to do with consuming dairy. A few times lately I have given up dairy to see if that was what was causing my sinus problems and sneezing and noticed that the pimples cleared up only to return when I had dairy again. I thought I was imagining it but maybe not.

      Annakay wrote on December 24th, 2013
    • Dairy provokes acne, and especially cystic acne, on my face and scalp. When I stopped consuming dairy to see if the acne would diminish, the night-time problems I had experienced with stuffy nose and stiff, achy knees cleared up (the nasal stuffiness within 2 days of eliminating dairy; the knee problems took a couple of weeks to vanish). That was 15 years ago. I adore dairy and have experimented with various forms; it all provokes acne if eaten even in small amounts 2-3 days in a row. Even butter at 2 tablespoons/day (up to 1 T/day is ok). Haven’t tested my tolerance for ghee or clarified butter. The good news (for a dairy lover): I can get away with small amounts of cheese or ice cream on an occasional basis.

      (Ms) Pat wrote on December 24th, 2013
  19. I stopped drinking milk about 3-4th grade, couldn’t stand the stuff. Mom always sent it in my lunch and I started pouring out on the way home from school. I love cheese and yogurt, not a big ice cream fan though. I’ve always thought that even as a child I knew somehow that I was lactose intolerant, and shouldn’t be drinking that stuff.

    Rema wrote on December 24th, 2013
  20. Some things my allergist taught me about dairy allergies – Sometimes you react to whatever the cow had been eating, especially various grasses, not the dairy protein itself. Of course, it could be corn or soy, too. I had all the skin prick testing some years ago and tested positive to quite a few grasses, things cows likely would eat in various seasons. But I did not react to dairy on the skin test, but the allergist told me food allergy testing done with skin tests is not as reliable as testing for pollen, mold, etc. Sometimes it can point you in the right direction, but as Mark stated, you really need to do an elimination diet and then a careful challenge later.

    So the dr said I might react to dairy during a particular season when the cows ate certain grasses at that time, but do just fine with dairy in another season. Just something to keep in mind.

    Also, the allergist had his patients return 24-48 hours after the skin prick tests because not all allergic reactions are immediate. They can also be delayed and indeed I had a couple of allergies that did not show up as welts right away but developed slowly over 24 hours, getting increasingly worse. He said those are the most dangerous. You can slowly get sicker and sicker and it becomes hard to pinpoint the culprit. He told me you can have a true allergic reaction as much as a week later and, of course, since we’ve eaten so many foods by then, it’s hard to know what really caused the problem. An elimination diet may not be easy, but it’s often the only way to really find out what foods (and most often it’s more than just one or two) you’re allergic to.

    Also remember dose is key! A little of one food might not bother you, but a little of several that you’re allergic to will “fill your allergy bucket to overflowing” – the dr used the analogy of a bucket to illustrate that you don’t experience the symptoms until you reach a point that overwhelms your body.

    Just some thoughts…

    Laurie wrote on December 24th, 2013
  21. For me the dairy intolerance is pretty clear-cut, after eating a bunch of dairy product I can clear out an entire football stadium. Strong men flee in fear of the gas cloud that is enveloping them. The U.N. assigned six people to monitor me 24/7 and threatened to impose sanctions if I continue to consume dairy.

    Joe Bob wrote on December 24th, 2013
  22. For 40 years, I drank milk, ate ice cream and enjoyed butter. (Never liked margarine.)

    I also had terrible hay fever (Rhinitis) and was to the point a few years back of taking Zyrtec in the morning and Benedryl in the evening. Yet, my nose was still runny and I felt continually clogged up.

    I then read a book my parents had regarding sugar allergies. In the book, the author mentioned anecdotal evidence of people with dairy allergies having bad mucus production. The lightbulb above my head went off and I stopped drinking milk, eating cheese and – shudder – ice cream.

    Instantly, my allergies went from horrid to barely noticeable. I still take Zyrtec most days, but that is about it. Anything with Whey or Caesin triggers the rhinitis. If I stay away, I’m fine.

    Kai Ponte wrote on December 24th, 2013
  23. Mark,
    This is a superb report on a confusing subject.
    It’s a pleasure reading your posts.
    Merry Christmas.

    Tom wrote on December 24th, 2013
  24. Read maybe 40 years ago that homogenization “straightens out” naturally “bent” lipid molecules allowing permeation directly into gut thus wreaking cardio havoc. Haven’t had whole milk as such since. Meanwhile, casien products (cheese and so on) affect me just like meat: small quantity (4-6 oz.) with plenty veggies=no problem.
    Mass quantity (like a 16 oz.T-bone steak or a brick of cheddar)=constipation and possible aggrivation of my chronic diverticulitis (heridetary exacerbated by years of SAD diet)

    Corey B. (Long Beach, CA) wrote on December 24th, 2013
  25. For years, I thought I was allergic to dairy and wouldn’t touch anything with dairy in it with a ten foot pole, then I found out I tolerate sheep dairy just fine, and nowadays I find that I tolerate fermented dairy fine as long as I don’t eat any grain

    Irene wrote on December 24th, 2013
  26. Whatever it is, the problem is only with American dairy. I can’t tolerate any of it! Lactose, whey, casin, etc, HOWEVER, I can eat dairy from Ireland with NO problems whatsoever, so, my issue is not with lactose, whey or casin, it’s with whatever they are doing to it in this country! If you have problems tolerating dairy, go to the store & buy some Kerrigold cheese & give it a try, you might just find that you are not lactose intolerant at all, but intolerant to your body being used an experiment by the US dairy industry!

    Val wrote on December 24th, 2013
  27. Mark,

    A little correction: the process to make italian ricotta (or paneer, which is the indian version) is to heat milk without bringing it to boil, add acid (vinegar or lemon juice for example), keep steering and hot until it curdles completely, finally filter through a cloth.

    In short, it is strained yoghurt without the fermentation. This makes ricotta a concentrate of fats and caseins (not of whey).

    My 2 cents ;)

    Primal_Alex wrote on December 24th, 2013
  28. Dairy is also full of corn derivatives- bad news If you are sensitive to corn or if you have a corn allergy. Many people have problems with corn but don’t know it, e.g., MSG, Aspartame, ascorbic acid, and so on. http://www.cornallergens.com/list/corn-allergen-list.php

    Leslie wrote on December 25th, 2013
  29. Why doesn’t anyone ever talk about the ability of dairy to cause headaches and even migraines? I’ve done a lot of experimenting with my diet over the years: vegan, macrobiotic, food-combining, etc etc. When I tried an Ayurvedic diet, which had me increase my already high dairy intake, I experienced the first migraine of my life — absolutely horrible! It lasted 24/7 for 6 days straight; after the 3rd day I couldn’t function at all. Imagine my surprise when I researched causes of migraines and found the top 3 websites listed dairy consumption on their home page! Why isn’t this more common knowledge?

    So I went dairy-free for 5 years and never had another migraine and even the “little” headaches went away that I’d been experiencing several times a week since I was a kid.

    Recently I’ve been experimenting with adding dairy back into my diet. I’ve discovered that I can enjoy a little bit every day. Butter and full-fat greek yogurt doesn’t seem to cause problems, but the headaches start up again if I overdo it with cheese and especially milk (organic or conventional) possibly because only pasteurized milk is available in AZ.

    Please pass the word to anyone suffering from migraines. It’s worth a try.

    Arienne wrote on December 25th, 2013
    • Yep, I can’t touch dairy since becoming pregnant in May. I get major migraines. I am also in AZ and you can get organic, raw milk at The Farm Shop on Riggs and Higley in Queen Creek. I have not tried it yet since that is a pretty long ways from me.

      Kandy wrote on December 26th, 2013
      • They have delivery routes that extend throughout the Phoenix area. Saveyourdairy.com has more info and it looks like you can contact them to get route info.

        ltreat wrote on January 4th, 2014
  30. I have found that the anti-fungal substance on bagged, shredded cheese upsets my stomach. I thought I had a dairy problem for a long time until experimenting with some different products (greek yogurt, butter, aged cheese in wax). No problems now! I think that a year of probiotics has helped the situation, too, but the shredded cheese is still a no-no for me.

    The Beckster wrote on December 25th, 2013
  31. Dairy is where my food allergen exploration started: it makes me sneeze, and that isn’t a typical allergy response, so it eluded me for YEARS! I always thought I had airborne allergies, not food allergies.

    Then one day (out of desperation), I popped a Benadryl to resolves a non-stop sneeze-fest. When I finally woke up 8 hours later, I noticed the life-long bags under my eyes went away.

    Then, after learning about the Paleo diet, and all the food eliminations I had to do to be on it, I noticed the sneezing stopped. Then, after reintroducing foods one at a time, I discovered (to my shock) that QUITE A FEW foods cause me trouble of differing sorts: some sneezing, some redness, some wheezing, some skin break-outs, some itching, and some an electric tingling in my fingers and toes. Coconut meat tightens the throat, and green bell peppers make me throw up. It’s gotten to where the only things that DON’T bother me reliably are meat and water…am I a natural-born carnivore? We’ll see.

    So now, potted plants, pets, and air fresheners are in the house, and many, many foods are not.

    Wenchypoo wrote on December 25th, 2013
  32. I use to never have a problem with dairy until a few years ago when I started making my own greek yogurt (used Greek Gods yogurt for new starter culture every 6th time). after eating that every day for a few months, started to get constant draining down the back of my throat. it stops when I stop eating dairy. and now when I eat dairy, I have constant throat clearing for a good half hour. if I eat Ben and Jerry’s too many nights in a row, the throat draining comes back. sucks – I love dairy.

    husband has been a mouth breather since a little boy. he sounds like Darth Vader half the time. He gets better (he doesn’t want to admit it) when we aren’t eating much dairy, but he’s so use to it, he’d rather not be able to breathe than cut out dairy. men.

    Midgy wrote on December 25th, 2013
  33. Even the ‘lactose intolerant’ generally manage on, or adapt to, RAW milk. Raw, grass-fed milk from any animal is no comparison to the 99% store-bought, industrialised crap most people drank and still suffer from.

    Trevor wrote on December 25th, 2013
    • Anybody get swollen face (maybe delayed insulin response) issues after anything dairy (cheese, milk, butter, cream, whey, etc)?

      I get swollen glands and puffy face after every dairy consumption, even a tablespoon. Also, anyone have tyramine issues?

      Annie wrote on December 25th, 2013
  34. I can’t drink milk, but can eat cheese and have heavy cream. I had stevia mixed with lactose as a sweetner once and my nose plugged up instantly. While I have no desire to drink milk I sure would like to be able to digest it in other forms like yogurt. Also, since stopping dairy for 3 months my stuffy nose and allergies are gone. However, my family uses a lot of dairy especially during the winter season. Lots of cheese and cCreole cream sauces. It’s once a year, but I hate suffering for it.

    honeytreebee wrote on December 25th, 2013
  35. A word on one of the above posts : I have never heard of any anti-fungal substance in pre-packed shredded cheese, but (here in the UK/Europe only?) potato starch IS added to stop the product sticking to itself in the bag. Blessedly, to the best of my knowledge, I have no allergy issues of any kind, though my mother, sister and one of my aunts are Type 2 diabetic (a VERY strong trait on my mother’s side; other relatives have it and both another aunt and my grandmother died of that) and suffer from IBS. In fact I can drink ordinary, bog-standard semi-skimmed cows milk by the litre and only (religiously) avoid it to forstall any potential addiction. My mother also has some rheumatism and my sister has a very rare glaucoma, arthritis and a recently-developed allergy to the pigment that makes fruits red, yet neither are willing to make any substantial dietary changes – my mother at least just doesn’t believe in it (it is also possible that they just won’t hear it from Me). With only occasional depression and about 45-50lbs too much fat on Me to worry about, I’m lucky and I know it; mixed Afro Caribbean ancestry would seem to be advantageous, if you can achieve it! Well-informed sources such as yourself are invaluable to those of us who really want to make changes – and I’ll keep working on the relatives :-)

    Alison wrote on December 25th, 2013
  36. If people have a hard time figuring out if they react to dairy, there is a blood test from Cyrex Labs. Below is a list of the components of dairy they test. Also included in the test are other foods that tend to cross-react to gluten. It’s helpful to be able to customize a patient’s diet using this test.

    Cow’s Milk IgG + IgA Combined
    Alpha-Casein & Beta-Casein IgG + IgA Combined
    Casomorphin IgG + IgA Combined
    Milk Butyrophilin IgG + IgA Combined
    Whey Protein IgG + IgA Combined
    Rye, Barley, Spelt, Polish Wheat IgG + IgA Combined
    Chocolate (Milk) IgG + IgA Combined
    Oats IgG + IgA Combined
    Yeast IgG + IgA Combined
    Coffee IgG + IgA Combined
    Sesame IgG + IgA Combined
    Buckwheat IgG + IgA Combined
    Sorghum IgG + IgA Combined
    Millet IgG + IgA Combined
    Hemp IgG + IgA Combined
    Amaranth IgG + IgA Combined
    Quinoa IgG + IgA Combined
    Tapioca IgG + IgA Combined
    Teff IgG + IgA Combined
    Soy IgG + IgA Combined
    Egg IgG + IgA Combined
    Corn IgG + IgA Combined
    Rice IgG + IgA Combined
    Potato IgG + IgA Combined

    Doc wrote on December 26th, 2013
    • Hey, that’s really interesting. All the combined food tests. Thanks.

      Annie wrote on December 26th, 2013
  37. I think the issue so many people have with the diary component of the Primal lifestyle is because many people find this way of eating after becoming severely health compromised. After years of throwing wheat and sugar down our throats, it’s probably not possible for there not to be moderate to severely major gut permeability issues. I think for Primal newbies, it may be best to look at increased gut permeability as the NORM, rather than the rare exception.

    Sean wrote on December 26th, 2013
  38. We found my 4 year old to be severely allergic to dairy when he was old enough for solids. We tried yogurt and he had an anaphylactic reaction. Soon after this discovery my mother had an allergy test at 61 years old and they said she was so allergic to casein she should carry an epi pen. She said all she noticed was sinus issues once in a while after consuming dairy. I went Paleo in January and was dairy-free for several months. I got pregnant in May and thought I would add back some dairy. I started getting migraines on and off. I finally made the association that dairy is now giving me migraines. I also realized that I have only managed to carry a pregnancy past the first trimester when off dairy. Not sure if the dairy issue will go away once the baby is born or if I have been like my mom and was never really aware I had a dairy allergy until now.

    Kandy wrote on December 26th, 2013
  39. I had thought that dairy caused acne for me, but now I’m not sure. I recently read something that said that it takes up to two months for a pimple to form. However, people claim that they break out in as little as a day from eating dairy. If it’s the former, it would be much harder to tell.

    Justin wrote on December 27th, 2013
    • It is confusing, Justin, but I just think of all the people–including me–who have broken out in a rash or hives after consuming something that doesn’t agree with their system. They can pop up within minutes, hours or a couple of days, so perhaps the kind of breakouts people get from dairy are different than the ‘average, normal’ pimple that’s usually caused by bacteria and sebum build-up? I don’t know for sure because of the conflicting info you referred to, but it’s just a thought….

      Tee Dee wrote on January 5th, 2014
  40. I have celiac disease and also have problems with milk. The strange thing is that I can drink milk if it has been scalded, or heated to boiling. I can eat some yogurt brands and some cheese brands, but not others. I haven’t fully figured out why. In the case of cheese and yogurt, I think it has to do with how the milk is treated before making the product. I am guessing that some of the brands of cheese and yogurt use heated milk which denatures the proteins prior to the culturing and curing processes. My guess it that when the proteins are denatured then I don’t react to the epitopes as they a have changed or altered 3-D conformation. This would also potentially explain my non-reaction to scalded to milk.

    Ed wrote on December 27th, 2013

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